Provider Demographics
NPI:1750656377
Name:IRINA MOGA DDS PC
Entity Type:Organization
Organization Name:IRINA MOGA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-646-5909
Mailing Address - Street 1:14425 SW ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4402
Mailing Address - Country:US
Mailing Address - Phone:503-646-5909
Mailing Address - Fax:503-646-5908
Practice Address - Street 1:14475 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4418
Practice Address - Country:US
Practice Address - Phone:503-646-5909
Practice Address - Fax:503-646-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8510261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental